Chicago: Occipital Headaches, Migraines and Occipital Neuralgia. Are Occipital Nerve Blocks the Answer?

Chronic migraines, chronic daily headaches sinus headaches are all issues arriving in the Trigeminal Nervous System and are in many ways the same problem.related.  Occipital headaches and occipital neuralgias have a different origins but there is a tremendous crossover both neurologically and structurally.

At the end of this article are patient testimonial videos but it is important to understand the concepts before watching the videos.

According to Johns Hopkins occipital neuralgia is "Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. There is one nerve on each side of the head. Emerging from between bones of the spine in the upper neck, the two occipital nerves make their way through muscles at the back of the head and into the scalp. They sometimes reach nearly as far forward as the forehead, but do not cover the face or the area near the ears; other nerves supply these regions.

Irritation of one these nerves anywhere along their course can cause a shooting, zapping, electric, or tingling pain very similar to that of trigeminal neuralgia, only with symptoms located on one side of the scalp rather than in the face. Sometimes the pain can also seem to shoot forward (“radiate”) toward one eye. In some patients the scalp becomes extremely sensitive to even the lightest touch, making washing the hair or lying on a pillow nearly impossible. In other patients there may be numbness in the affected area. The region where the nerves enter the scalp may be extremely tender." 

What Johns Hopkins does tell patients is that the position of the head , jaw and neck are closely related and that neck and jaw problems caused by  overclosure  or malpositioning of the mandible can create excessive pressure on posterior nerves and muscles .

Johns Hopkins says "Occipital Neuralgia may occur spontaneously, or as the result of a pinched nerve root in the neck (from arthritis, for example), or as the result of prior injury or surgery to the scalp or skull. Sometimes “tight” muscles at the back of the head can entrap the nerves." but they ignore the easiest to fix problem, the bite.

The Quadrant Theorem of Guzay clearly shows the relation of the head and jaw position to the first two cervical vertebrae.  These connections are the structural key to understanding how neck problems interact with the Trigeminal Nervous System and the TrigeminoVascular system to cause headaches.

Whenever the answer to a problem requires different professions to work together  patient frequently suffer form incomplete or partial treatment.

I posted this in response to a question about occipital nerve blocks on Reddit.com  

Migraines and Occipital Nerve Blocks

Occipital and greater occipital blocks are very good at relieving a severe headache (migraine or muscle) but not preventing future ones. Trigger point injections should follow the occipital nerve block to decrease future headaches and with the block they are painless. The headaches relieved are marked by the dermatone figure.https://en.wikipedia.org/wiki/Greater_occipital_nerve#/media/File:Gray784.png.
Remember, most migraines and headaches can have cervical input but are primarily trigeminal in nature as seen in above dermatone
SPG blocks are far more effective for turning off an acute migraine and have a longer effect and help reduce future migraines.
Headaches and migraines (almost 100%) are caused (mediated) by the Trigeminal nerves. The Sphenopalatine Ganglion is a parasympathetic ganglion and blocking it has been shown effective in treating and turning off migraines. Parts of trigeminal nerve pass thru SPG. A block can be performed from a facial approach, an intraoral approach or an intranasal approach. Intranasal can be performed at physicians office or prophylactically at home to eliminate most headaches and migraines. For Acute pain facial injection is the best choice, to eliminate future headaches daily or twice daily appllication is best choice. Newer methods such as Sphenocath or TX360 are done periodically at physicians office. Less effective than injections for acute pain.
The dermatone chart shows distribution of Trigeminal vs occipital (cervical) nerves. Occipital or greater occipital block only addresses cervical component not the central trigeminal component of headache or migraine.
The Trigeminal Nerve is where almost 100% of headaches arise. This is usually due to nociceptive input into the trigeminal nerve. This is where Botox has an effect. There are better alternatives that don't involve injecting toxins to decrease nociception to Trigeminal Nerve.
The NTI appliance is FDA approved to prevent migraines and is a small oral appliance. It works for some people but can cause a host of adverse effects (much less than drugs). Neuromuscular Dentistry is the best way to decrease nociception into the Trigeminal Nervous System and can eliminate migraines or severely decrease frequency and severity.www.ICCMO.org represents neuromuscular dentistry at its best. There are qualified neuromuscular dentists (NMD)who are not members of ICCMO but the best NMD are usually members of ICCMO the premiere research and education group founded by Barney Jankelson, the father of Neuromuscular Dentistry.
All neuromuscular dentists are not the same.
All neuromuscular dental treatment should begin with a diagnostic neuromuscular orthotic and it is important to only consider other treatment if very significant improvement in headaches and migraines is seen within 5-7 visits.
A long term stabilization may be necessary but this does not mean you need reconstruction. Long tem removable orthotics are a very viable option as is orthodontics, Epigenetic orthodontics (DNA APPLIANCE)

The long term stabilization is key to controlling occipital neuralgia and headaches .

http://thinkbetterlife.com/crps-chicago-complex-regional-pain-syndrome-can-respond-spg-blocks/
http://thinkbetterlife.com/sphenopalatine-ganglion-spg-block-for-headaches-migraines/
http://www.sleepandhealth.com/story/suffer-no-more-dealing-great-impostor

#OcciptialNerveBlockMigraine,#occipitalnerveblocktmj,#occipitalNerveBlockSPGBlock,#MigrainepreventionSPGBlock,#Migrainepreventionoccipitalblocks

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Neuromuscular Dentistry: Effective Relief of Migraine and Chronic Daily Headache

Neuromuscular Dentistry is incredibly successful in helping migraine and chronic daily headache for patients as well as other TMJ disorders.  Why is such an effective treatment so controversial.  The history of Neuromuscular Dentistry is important.

Neuromuscular Dentistry was the brain child of Dr Barney Jankelson a Seattle Prosthodontist Specialist who studied the physiology of normal muscles and how ULF TENS could relax muscles to their physiologic resting position.

I had the privilege of studying with with Barney  "Dr J" and I remember asking a couple of questions during his lecture.  He put his arm on my shoulder and said "great question" and I spent the next two days discussing neuromuscular dentistry, physiology and his philosophy.  He loved the science of Neuromuscular Dentistry.

I have been enthralled with the underlying science of Neuromuscular Dentistry for years.  As new research on migraines, chronic daily headache is published it always fit the paradigm the Dr J imagined.

This was a giant leap in dentistry and it created many adversaries.

The biggest contention was the use of biomedical devices to measure what was actually happening during function.  When these measurements  showed old theories were flawed there was a tendency to attack the measurements.  Those who had based their careers  these theories were critical of neuromuscular dentistry

The idea of Centric Relation was an old mechanical viewpoint of where the jaws functioned.  Measurement showed that these assumptions were wrong.  The definition of Centric Relation went thru at least 26 revisions over time many because new technology showed that the definition was not physiologically functional.

Doctors who believed in Centric Relation attacked the science of measurement because they like the the fact that it did not agree with their theories.

Dr J stated "If it is measured it is a fact otherwise it is an opinion"

In spite of numerous attacks on neuromuscular measurement devices including some that extended into illegal and unscrupulous dealings within the FDA the ability and right to measure accurately survived.  The neuromuscular instrumentation has been shown to be safe and effective by the ADA and FDA.  More importantly, patients have experienced life changing improvements in their quality of lives directly because of Neuromuscular Dentistry.

An entire FDA panel was suspended and several unscrupulous characters are no longer involved with the FDA after an internal investigation showed evidence of malfeasance.

The real winners from neuromuscular dentistry are patients whose lives are vastly improved by elimination of chronic pain, headaches migraines and other problems thru the use of Neuromuscular Dentistry.

Chicago Migraine: Is Neuromuscular Dentistry and Reductions in CGRP the best Migraine Treatment?

Understanding CGRP and Why Neuromuscular Dentistry Relieves and Eliminates Migraines 

Neuromuscular Dentistry can reduce CGRP levels and reduce the number and severity of migraines and possibly eliminate migraines.

Learn more about Neuromuscular Dentistry in the  Chicago area at

 www.ThinkBetterLife.com and at www.NorthShoreSleepDentist.com

At least three  pharmaceutical companies are currently investigating drugs to block CGRP according to: Bloomberg July 21, 2015 in an article by David Wainer titled "The Pharma Industry Thinks It Finally Has A Fix For Migraines"

According to Bloomberg, "Amgen, Alder, Lilly and Teva are developing drugs aimed at erasing those episodes entirely -- at least in some patients -- by blocking CGRPs, or calcitonin gene-related peptides, which play a role in inflammation and transmission of pain.

The Calcitonin Gene-Related Peptide that the pharmaceutical companies are trying to block can be controlled by changing the neural input into the Trigeminal Nervous System.

 CGRP is  released by the Trigemino-Vascular System in the cell bodies of trigeminal nerves located with the Trigeminal Ganglion.  This is the primary source of CRGP related to headaches.  Decreasing of Nociceptive input by utilizing Neuromuscular Dentistry will prove to be a cure for many migraine sufferers.

Utilizing a Diagnostic Neuromuscular Orthotic during phase 1 treatment can determine effectiveness of Neuromuscular Dentistry in alleviating or eliminating migraines in a non-invasive manner.  Treatment is reversible if patients do not experience significant improvement or elimination of migraines.

The way Neuromuscular Dentistry affects CGRP is by removing nociceptive input to the CNS, particularly into the Trigeminal Nervous System and negating the production of CGRP.

CGRP is a potent vasodilator and works by the Trigeminal Nervous system control of blood flow to the anterior two thirds of the meninges of the brain.  This is a primary proposed mechanism in Migraine and other neurovascular pain conditions.

The drug companies want to block CGRP's that play a significant role in inflammation and transmission of pain.    They also want to partake in the estimated 8 billion dollars or more that the migraine market can generate.

According to Wikipedia:

• "In the spinal cord, the function and expression of CGRP may differ depending on the location of synthesis. CGRP is derived mainly from the cell bodies of motor neurons when synthesized in the ventral horn of the spinal cord and may contribute to the regeneration of nervous tissue after injury. Conversely, CGRP is derived from dorsal root ganglion when synthesized in the dorsal horn of the spinal cord and may be linked to the transmission of pain."

If the drug companies treat with CGRP blocking agents will this adversely interfere with healing or could it contribute to Dementia, Alzheimers or other neurological problems.  

Correcting CGRP by changing neural input into the Trigeminal Nervous System via neuromuscular dentistry is probably the safest, most physiologic and efficient means of reducing or eliminating migraines thru reduction in CGRP Levels.

Unfortunately for Migraine patients the value of treatment with drugs is 8 Billion dollars so all research is directed toward the largest financial returns.  Effective and safe migraine alleviation and elimination with SPG Blocks and Neuromuscular Dentistry receive minimal funding for studies in spite of effectiveness.

Understanding CGRP and Why Neuromuscular Dentistry Relieves and Eliminates Migraines

Calcitonin gene-related peptide is the new target for the Pharmaceutical industry for treating Migraines!  

At least three companies are currently investigating drugs to block CGRP according to: Bloomberg July 21, 2015 in an article by David Wainer titled "The Pharma Industry Thinks It Finally Has A Fix For Migraines"

According to Bloomberg, "Amgen, Alder, Lilly and Teva are developing drugs aimed at erasing those episodes entirely -- at least in some patients -- by blocking CGRPs, or calcitonin gene-related peptides, which play a role in inflammation and transmission of pain.

The Calcitonin Gene-Related Peptide is probably the same mechanism that allows Neuromuscular Dentistry to alleviate and eliminate migraines and chronic daily headaches.  CGRP is produced by the Trigemino-Vascular System in the cell bodies of trigeminal nerves located with the Trigeminal Ganglion.  This is the primary source of CRGP related to headaches.

The way Neuromuscular Dentistry affects CGRP is by removing nociceptive input to the CNS, particularly into the Trigeminal Nervous System and negating the production of CGRP.

CGRP is a potent vasodilator and works by the Trigeminal Nervous system control of blood flow to the anterior two thirds of the meninges of the brain.  This is a primary proposed mechanism in Migraine and other neurovascular pain conditions.

The drug companies want to block CGRP's that play a significant role in inflammation and transmission of pain.    They also want to partake in the estimated 8 billion dollars or more that the migraine market can generate.

According to Wikipedia:

• "In the spinal cord, the function and expression of CGRP may differ depending on the location of synthesis. CGRP is derived mainly from the cell bodies of motor neurons when synthesized in the ventral horn of the spinal cord and may contribute to the regeneration of nervous tissue after injury. Conversely, CGRP is derived from dorsal root ganglion when synthesized in the dorsal horn of the spinal cord and may be linked to the transmission of pain."

If the drug companies treat with CGRP blocking agents will this adversely interfere with healing or could it contribute to Dementia, Alzheimers or other neurological problems.  

Correcting CGRP by changing neural input into the Trigeminal Nervous System via neuromuscular dentistry is probably the safest, most physiologic and efficient means of reducing or eliminating migraines thru reduction in CGRP Levels.

Unfortunately for Migraine patients the value of treatment with drugs is 8 Billion dollars so all research is directed toward the largest financial returns.  Effective and safe migraine alleviation and elimination with SPG Blocks and Neuromuscular Dentistry receive minimal funding for studies in spite of effectiveness.

Warnings on NSAIDS: Ibuprofen, Advil, Alieve, Motrin and similar drugs.

This post from the American Headache Society makes a case for alternative treatments for Headaches including SPG Blocks and Neuromuscular Dentistry.

Just taking non-steroidals drugs for pain may be ok but read this new warning from the American Headache Society:

American Headache Society Wants Patients, Physicians to Know About New FDA Warning on NSAIDs About Heart Attack and Stroke Risk

July 16, 2015 12:00 PM (not rated)

For Immediate Release

AMERICAN HEADACHE SOCIETY WANTS PATIENTS, PHYSICIANS TO KNOW ABOUT NEW FDA WARNING ON NSAIDS ABOUT HEART ATTACK AND STROKE RISK

People Taking These Anti-inflammatory Drugs Should Speak With Their Physician; When Prescribed, Low Dose and Short Duration Recommended

MOUNT ROYAL, NJ (July 16, 2015)– The American Headache Society wants people with migraine and other headache disorders, as well as their physicians, to know that the U.S. Food & Drug Administration (FDA) has issued a new warning about possible heart attack and stroke risk for people taking nonsteroidal anti-inflammatory drugs (NSAIDs). The FDA has identified an elevated risk, even for those who have no known heart disease or stroke risk factors. The FDA will require manufacturers to include information in their drug packaging that discusses these risks. The warning covers popular over-the-counter NSAIDs such as Advil®, Motrin® and Aleve®, as well as prescription medications. The new warning does not apply to aspirin, which is a different type of NSAID.

            "Physicians should prescribe NSAIDs with caution, and consider other treatment options, especially for longer term treatment," said Lawrence C. Newman, MD, FAHS, President of the American Headache Society and Director of the Headache Institute at Mount Sinai-Roosevelt Hospital (New York City). "If NSAIDs must be used, it would be prudent to give the lowest possible dose for the shortest period of time."

            According to the FDA, heart attack or stroke risk can occur as early as a few weeks after beginning NSAIDs, and longer use may further increase risk.  Use of NSAIDs after a heart attack raises risk of death within the first year.  The use of NSAIDs also increases the chances of developing heart failure.  It is unknown if some NSAIDs are riskier than others.

"Many people with migraine and headache take NSAIDs on a daily or occasional basis," added Dr. Newman. "The take home for patients is to become educated about this new warning, and speak with their doctor. They should also reduce their controllable heart attack and stroke risk factors by not smoking, keeping their weight within normal limits, avoiding excess alcohol intake and working with their physician to keep cholesterol, blood pressure and diabetes under control."

            The FDA has stated that the risk of heart attack or stroke for those taking NSAIDs is even greater than originally thought when it was first identified in 2005.   

            People taking NSAIDs should be aware of symptoms of heart attack and stroke, and seek immediate medical attention if any of these are present:

· Chest pain

· Shortness of breath

· Difficulty breathing

· Weakness on one side of the body

· Slurred speech

For more information, go to http://www.americanmigrainefoundation.org/fda-see​s-stronger-link-between-popular-pain-meds-and-heart-attack-or-stroke/ or http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm

ABOUT MIGRAINE: Some 36 million Americans live with migraine, more than have asthma and diabetes combined. An estimated three to seven million Americans live with chronic migraine, a highly disabling neurological disorder. Migraine can be extremely disabling and costly, accounting for more than $20 billion in direct (e.g. doctor visits, medications) and indirect (e.g. missed work, lost productivity) expenses each year in the United States.

ABOUT THE AMERICAN HEADACHE SOCIETY: The American Headache Society (AHS) is a professional society of health care providers dedicated to the study and treatment of headache and face pain. The Society's objectives are to promote the exchange of information and ideas concerning the causes and treatments of headache and related painful disorders. Educating physicians, health professionals and the public and encouraging scientific research are the primary functions of this organization. AHS activities include an annual scientific meeting, a comprehensive headache symposium, regional symposia for neurologists and family practice physicians, and publication of the journal Headache.  www.americanheadachesociety.org

Migraine Treatment: Sphenopalatine Ganglion (SPG) Blocks are they a Magic Migraine Cure?

The Sphenopalatine Block has been called by some the Miracle Headache Cure after being popularized in the best selling book "Miracles on Park Avenue:  Techniques for Treating Arthritis and Other Chronic Pain" by Albert Benjamin Gerber.

While not a "MIRACLE CURE" it is definitely miraculous treatment for many patients.

The Sphenopalatine Ganglion (SPG)  (also called pterygopalatine ganglion, Meckel's Ganglion or the Nasal Ganglion) is the largest parasympathetic autonomic ganglion a group of nerve cells that is linked to the trigeminal nerve.  

The Trigeminal Nerve is the primary nerve involved in all migraines and other headaches.  

The Trigeminal Nerve is usually called the Dentist's Nerve because dentists are considered the experts in most peripheral aspects of the Trigeminal Nerve structures. The Trigeminal Nerve goes to the teeth, the gums (gingiva), the periodontal ligaments, the jaw joints (TMJ, TMJoint) or TemporoMandibular Joints, the lining of the sinuses, the jaw muscles, the tensor of the ear drum and the muscle that opens and closes the eustacian tube, the lacrimal glands (tear ducts) and is responsible for nasal congestion.

The Trigeminal Nerve is also the major control of blood flow to the anterior 2/3 of the meninges of the brain and central to almost 100% of headaches.  The Trigeminal Nerve accounts for over 50% of the total input to the brain after amplification in the Reticular Activating System.

TMJ Disorders are often called "The Great Imposter because the can mimic all types of headaches, migraines, sinus problems and ear problems.  The majority of chronic headache patients have similar myofascial pain at patients with TMJ.  Neuromuscular Dentistry can be the best treatment for many patients with chronic headaches.  Learn more at WWW.ThinkBetterLife.com.  

The SPG is located behind and lateral nose in the pterygopalatine fossa, and carries information about sensation, including pain, and also plays a role in autonomic functions, such as tearing and nasal congestion. 

The application of local anesthetics to the SPG and the trigeminal nerve can be extremely effective in eliminating and/or controlling all types of head pain including tension headaches, chronic daily headache, new persistent daily headache, Cluster headaches, and migraine staticus.  I

SPG blocks can be accomplished by nasal swaps placed intranasally, injections intra-orally or from externally (Most effective) and recently three devices have been FDA approved for performing SPG blocks.  These devices involve placing  anesthetic through a thin cannula that passes through the nasal cavity to insert numbing medication in and around the Sphenopalatine ganglion area where it passes through the mucosa ti the ganglion.  These devices are less invasive than the injection technique but also less effective.  The three devices are the Sphenocath®, the  Allevio®, and the Tx360®.

The nasal swabs have an enormous advantage as they can be self applied by patients on a daily basis and when done with continuos delivery are amazingly effective and very inexpensive.  

Different types of anesthetic solutions can be utilized with any of these techniques.

The nasal swabs are left in place for 20 minutes to 30 minutes if done in my office.  Patients with severe problems can actually leave them in longer and self apply a couple of times a day.   The most common side effects, regardless of how SPG blocks are given are all temporary, including numbness in the throat, low blood pressure, and infrequently nausea. 

References:

Maizels, M; Scott B; Cohen W; Chen W. Intranasal lidocaine for treatment of migraine: a randomized, double blind, controlled trial. JAMA 1996;27:319-21.

Piagkou, M; Demesticha, T; Troupis, T; Vlasis, K; Skandalakis, P; Makri, A; Mazarakis, A; Lappas, D;Piagkos, G; Johnson, EO. "The pterygopalatine ganglion and its role in various pain syndromes: from anatomy to clinical practice." Pain Pract. 2012;12(5):399-412.

Jenkin,s B; Tepper, SJ. "Neurostimulation for Primary Headache Disorders, Part 1: Pathophysiology and Anatomy, History of Neuromodulation in Headache Treatment, and Review of Peripheral Neuromodulation in Primary Headaches." Headache 2011;51:1254-1266.

Martelletti, P; Jensen, RH; Antal, A; Arcioni, R; Brighina, F’ de Tommaso, M; Franzini, A; Fontaine, D;Heiland, M; Jürgens, TP; Leone, M; Magis, D; Paemeleire, K; Palmisani, S; Paulus, W; May, A. "Neuromodulation of chronic headaches: position statement from the European Headache Federation." J Headache Pain 2013;14(1):86.

Khan, S; Schoenen, J; Ashina, M. "Sphenopalatine ganglion neuromodulation in migraine: What is the rationale?" Cephalalgia 2014;34(5:382–391.

Schoenen, J; Jensen, RH; Lantéri-Minet, M; Láinez, MJ; Gaul, C; Goodman, AM; Caparso, A; May, A. "Stimulation of the sphenopalatine ganglion (SPG) for cluster headache treatment. Pathway CH-1: a randomized, sham-controlled study." Cephalalgia. 2013 Jul;33(10):816-30.